To improve men’s health, treat the cause not just the illness

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Science Communications at Hawkesbury Institute for the Environment (UWS), Western Sydney University

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John Macdonald receives funding from NSW Health and the Commonwealth Department of Health and Ageing.. He is affiliated with the Australasian Men's Health Forum of which he is current President and is a professor at UWS.

Whichever way you look at it, men’s health in Australia is uniformly worse than women’s. Men die, on average, five years earlier than women born at the same time and are likely to experience more health complaints throughout their life.

This is despite years of well-executed campaigns designed to motivate men to reduce risky behaviours: cut down on booze, quit smoking, eat healthily and drive safely.

But viewing barriers to good health simply as behaviours that must be “dealt with” overlooks the broader environment of men’s lives – the “causes of the causes” of poor health.

The Commonwealth Government’s 2010 National Male Health Policy marked a promising departure from this traditional view of men’s health.

For the first time, policy makers acknowledged the impact of life factors – income, relationships, food, housing, family life, transportation and stress – on men’s overall health.

What we need now is for this policy shift to translate to changes in health service delivery and health promotion initiatives.

Rather than just treating illness, health professionals must consider how a person’s life “road map” influences the current and future state of their health.

Currently, if a man presents to his doctor with chest pains, he’ll immediately have checks on the health of his heart. But subsequent assessments are also needed to determine whether life factors are also to blame.

If demands at work are layered with relationship stress, and a two-hour daily commute prevents him from seeing his kids before bedtime, his physical health may well be a product of ongoing stressors in his life.

A treatment plan which addresses these stressors, is therefore likely to have more impact on his health than any technological or medical initiative alone.

This has been done in the Health Leads program in the United States, where physicians “prescribe” food, housing, health insurance, job training, fuel assistance, or other resources for their patients as routinely as they do medication.

Results show this approach is relieving the burden on doctors and leading to better patient outcomes than traditional prescriptive approaches to care.

We still have a long way to go in Australia but one organisation – the Men’s Shed movement – is making ground.

The sheds are a place for men of all ages to informally meet and collaborate on projects such as restoring furniture, fixing bicycles or making kids’ cubby houses.

The sheds engage men in positive environments that promote their health and well-being with feelings of connectedness, satisfaction of achievement and reward for their contributions.

In the sheds, men can communicate “shoulder to shoulder”, while working on project, rather than talk to each other face to face. This reflects the way most men prefer to communicate and avoids perceptions of being lectured, admonished or disciplined.

“The Shed” at Mount Druitt in Western Sydney is another example of a health program considering the broader context of men’s lives – in this case, in an effort to prevent suicide.

The Shed offers a safe place where men can socialise with each other and connect with local services such as Legal Aid, housing providers and Centrelink.

Our own research has shown that suicide is often the last resort for men who have lost – and haven’t been able to regain – the factors that kept them alive.

A man may lose his job, which may lead to financial problems that cause him to lose his house and damage his relationships. He may turn to alcohol, drugs or gambling and, progressively, see his reasons to live diminish.

Health-giving environmental factors can work both ways. Being employed, for example, is universally acknowledged as one of the most important factors in men’s health outcomes.

Employment offers the opportunity for achievement, income, a sense of being valued and socially connected – all improving overall health and well-being.

At the same time, men exposed to stress, physical danger, job insecurity, long commutes or isolation at work are as likely to have poor health outcomes as unemployed men. What counts is the overall balance.

To improve the health of Australian men, we must build a culture that examines men’s wellness as much as their illness.